Chickenpox with a Fever So High He Couldn’t See or Hear?
What people search for: chickenpox / chickenpox with high fever / fever so high you pass out / delirium with loss of sight / falling ill from hard work / pox that won’t come out
Medical terms: chickenpox (pox rash) · exhaustion from overwork (lao shang, 劳伤) · deficiency of upright qi · deficiency-type fever · pathogen sinking inward due to weakness
The opening scene: chickenpox was sweeping the neighborhood — and this young man was the first to collapse
The great Yuan-dynasty physician Doctor Zhu Danxi (朱丹溪) tells us about a young man of sixteen or seventeen. You might wonder: at sixteen or seventeen, why does the record call him a “man”? Because in ancient times people were considered adults much earlier — at that age a boy could already marry and start a household — so the case record solemnly writes down “a man.”
At the time, chickenpox was raging through Doctor Zhu Danxi’s hometown — shi li zhong duo fa dou zhe: household after household in the neighborhood was coming down with the pox.
💬 Note from Doctor Luo: In ancient times, chickenpox was a very big deal. It spread ferociously, and people died from it. We forget this today because the chickenpox vaccine has made the disease rare. But in the Yuan dynasty, if a child in your house came down with the pox, the whole family held its breath.
How sick was he? He couldn’t see, and he couldn’t hear
This young man did not have an ordinary cold. It began with fa re er hun — a high fever with clouded consciousness. How bad was it? The case record says it in four characters: “mu wu shi, er wu wen” — his eyes could not see, his ears could not hear. His eyes did not even open; you could speak to him and he would not hear you.
💬 Note from Doctor Luo: When a patient can neither see nor hear, the consciousness is seriously clouded — this is a very severe case. The family urgently called Doctor Zhu Danxi to take the pulse. As soon as he felt it: both wrists showed a large, hollow, slightly rapid pulse (liang shou mai jie huo da er lue shu) — the pulse was big, but pressing on it felt empty, and it beat a little fast.
One touch of the pulse and Doctor Zhu Danxi understood: this was “lao shang” — exhaustion from overwork
A pulse that is large and hollow — what is that? Lao shang (劳伤): injury from exhaustion. When a person is extremely depleted, the body is still struggling desperately to keep running normally, and the pulse shows this big, empty, deficient quality. And what about the rapid beat? Most people assume a fast pulse means heat — heat makes the pulse rapid, cold makes it slow; that is true. But a deficient person’s pulse can also be rapid: when the body is weak, the heart has to beat double time, working itself to exhaustion — so the pulse speeds up.
💬 Note from Doctor Luo: The principle that “deficiency can also produce a rapid pulse” was discussed in depth by the great Ming-dynasty physician Doctor Zhang Jingyue (张景岳), who explained it very clearly. And Doctor Zhu Danxi’s habit of “looking at the upright qi first” was a foundation he learned from his own teacher, Doctor Luo Zhiti (罗知悌, also known as Luo Taiwu): when you examine a patient, first ask how much zheng qi (正气, upright qi) this person has left.
One piece of good news in a crisis: he still knew to drink porridge
The young man was unconscious — but Doctor Zhu Danxi noticed one crucial thing: give him medicine and he swallows it; give him porridge and he eats it.
💬 Note from Doctor Luo: This is excellent news, for two reasons. First, it means his consciousness was not completely lost — the illness had not yet reached its most critical stage. Second, being able to eat is what we call “wei qi shang cun” — the stomach qi is still intact. The stomach qi is where the body’s resources come from; as long as it survives, treatment has hope. So Doctor Zhu Danxi said: forget for now whether the pox will erupt; right now this man is simply depleted — saving his strength comes first.
The prescription: ginseng and astragalus at the base, with angelica, atractylodes and a touch of tangerine peel
Doctor Zhu Danxi wrote: ren shen (人参, ginseng) and huang qi (黄芪, astragalus) to restore upright qi, dang gui (当归, angelica sinensis) to nourish the blood, bai zhu (白术, atractylodes) to strengthen the spleen and stomach, plus a small amount of chen pi (陈皮, aged tangerine peel) to move the qi — so the tonics would not just pile up and clog the middle. The doses were substantial, and the herbs were decocted into a strong, concentrated soup to drink.
💬 Note from Doctor Luo: Notice that Doctor Zhu Danxi’s prescription was nothing like the stereotype of “always cool and nourishing yin”! Formulas built on ginseng and astragalus appear again and again in his case records. When qi is sufficient, qi generates blood — add dang gui and the blood-nourishing effect is even better. So when evaluating an ancient physician, never repeat rumors secondhand. Some people say with a wave of the hand, “Zhu Danxi damaged yang qi” — just look at this formula. Does this damage yang qi?
After twenty doses, the scariest sight yet: pox covering every inch of his skin
After the strengthening medicine, more than twenty doses in, the pox finally erupted: “cheng nong pao, shen wu wan fu” — it became pus blisters, with no patch of healthy skin left anywhere on his body. Terrifying to look at — but in fact this was a good sign.
💬 Note from Doctor Luo: Why had he been so gravely ill before? Because when a person contracts chickenpox while upright qi is extremely deficient, the pathogen travels inward — when evil qi sinks inward it is called “ni” (逆, counterflow), the most dangerous direction. Once the upright qi is replenished, the body regains the strength to fight, and the pathogen moves outward — that is called “shun” (顺, with the flow). Eruption means the body is driving the illness out. But at this moment some people panicked: the condition looks so dreadful — why not use the Chen family formula to treat him? Doctor Zhu Danxi shook his head.
Warming yang lights the fire; supplementing deficiency adds the wood — “This man is only deficient, not cold”
The “Chen family formula” (Chen shi quan fang) comes from Doctor Chen Wenzhong (陈文中) of the Southern Song dynasty, author of the Xiao Er Dou Zhen Fang Lun (《小儿痘疹方论》, Treatise on Pox Rash Formulas for Children) — which followed the pox monograph written by Doctor Dong Jizhi (董及之), a disciple of the famous pediatrician Doctor Qian Yi (钱乙). The book’s doctrine: when yang qi is insufficient, use hot, dry, aggressive herbs such as fu zi (附子, aconite), ding xiang (丁香, clove) and rou gui (肉桂, cinnamon) to warm the yang.
💬 Note from Doctor Luo: For a person who is genuinely yang-deficient, this approach can work. But the book became so popular that doctors slapped warming-drying herbs on every case of chickenpox — with disastrous results. Doctor Zhu Danxi later wrote about it specifically: in the spring of the jiashen year of the Zhizheng era (1344), yang qi stirred early; in the first month, pox was epidemic in more than one household — and many physicians used the Chen family formula, killing more than a hundred young children! Using warming-drying herbs without matching the pattern kills. So when someone urged Doctor Zhu Danxi to use the Chen family formula, he answered with one sentence: “ci dan xu er wu han ye” — “This man is only deficient, but not cold.” There is no cold to warm; warming yang is not called for.
Here Doctor Zhu Danxi laid out a great principle in plain words: warming yang is lighting a fire; supplementing deficiency is adding firewood. Fu zi and gan jiang (dried ginger) are the spark — but you must have fuel first. Without provisions, the fire will not catch.
💬 Note from Doctor Luo: Lacking firewood is deficiency (xu) — so you add fuel: to strengthen the spleen, use huang qi, huai shan yao (Chinese yam) and bai zhu; to strengthen the kidney, use ba ji tian (morinda), chuan duan (dipsacus), gou qi (goji berry) and rou cong rong (desert cistanche) — all of these are “adding wood.” Only when the wood is piled up can you strike the spark; then fu zi and gan jiang will make the yang blaze up at once. You must distinguish deficiency from cold, and the order of the herbs matters: if the cold is severe, warm first and supplement later; or you may warm the yang and supplement the deficiency together. When to combine them, which dose should be heavy and which light, and what order to use — you need to know all of it. Knowing only how to warm the yang is half a lesson; knowing only how to supplement deficiency is half a lesson. You need both.
Dozens more days — the pox withdrew, and the real cause came out
Doctor Zhu Danxi ignored the advice and kept strengthening the body. After several more tens of days, the pox gradually dried up and healed — the illness was gone. After recovery, he asked the young man: how did you become so depleted? The young man said: I saw that all the neighbors’ children were getting chickenpox, and I was afraid of catching it myself — so I went up the mountain to chop wood with all my might, day after day, working up a drenching sweat, thinking that sweating would drive the evil qi away… But day after day of heavy sweating carried away his upright qi along with it.
💬 Note from Doctor Luo: Doctor Zhu Danxi understood at once: this was exactly lao shang — exhaustion from overwork! The young man’s daily diet had never been good, his spleen and stomach were already injured, and his upright qi was insufficient. On top of that he drained himself with violent sweating — so when the external pathogen arrived, his reaction was severe: first the fever, then the coma. Doctor Zhu Danxi said: if the Chen family formula had been used to warm his yang at the start, “ning wu hou hui” — there would have been nothing but regret. Throughout the entire treatment, Doctor Zhu Danxi never used a single standard chickenpox formula — and especially not the fashionable warming-drying approach. He held on to one word: “deficiency” — and simply kept strengthening the body. Once the upright qi was sufficient, the pox erupted on its own; after it erupted, he kept strengthening, and the pox receded on its own. What was truly cured was the body itself.
Doctor Luo’s postscript: see the person first, then the disease
Doctor Luo says the lesson of this case is a theme that runs through Doctor Zhu Danxi’s case records again and again.
💬 Note from Doctor Luo: First, you must see the person who is sick. We habitually fix our eyes on the “disease” — we hate the disease, and wish a single dose could knock it out. But often, while you are busy attacking the illness, you damage the patient’s upright qi — the qi grows weaker and weaker, the condition turns sharply for the worse, and finally nothing can control it. Doctor Zhu Danxi, when he saw a patient, first assessed how much upright qi remained in reserve; if it was insufficient, he built it back up before doing battle. Second, supplementing deficiency and warming yang are not the same thing: warming yang is striking the spark; supplementing deficiency is adding the wood. Once you understand the relationship between the two, you will write prescriptions with far greater clarity.
Compiled from Doctor Luo Dalun’s lecture on Doctor Zhu Danxi’s case records. The case comes from the pox chapter of Doctor Zhu Danxi’s Ge Zhi Yu Lun (《格致余论》, Inquiry into the Properties of Things) and his collected case records.
What to take away
- When a person is this depleted, the first job is to restore upright qi — not to attack the pox. The pox erupts when the body is strong enough to push it outward; that outward eruption is the body healing itself.
- “Warming yang is striking the spark; supplementing deficiency is adding the wood.” If the wood is missing, the spark cannot catch. Know whether your patient is deficient, cold, or both — and in what order to treat them.
- A rapid pulse does not automatically mean heat. Deficiency can also speed the pulse up; a big, hollow pulse signals exhaustion, not fire.
- Stomach qi is life’s lifeline. A patient who can still eat and swallow has a source of resources — and therefore hope.